| International FP-005 |
| Differentiating Age-Related Optic-Nerve-Head Change from Early Glaucoma in Elderly Patients. |
| Department of Medicine, Seoul National University College of Medicine, Seoul, Korea(1)
Department of Ophthalmology, Seoul National University Hospital, Seoul, Korea(2)
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| Ahnul Ha(1,2), Young Kook Kim(1,2), Jin Wook Jeoung(1,2), Ki Ho Park(1,2) |
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Purpose : To answer the question: In the elderly, ‘age-related optic-nerve-head (ONH) change’ and ‘early glaucoma’ can be distinguished?
Methods : 72 eyes of 72 elderly (65+ years) with large vertical cup-to-disc ratio (VCDR≥0.8) without any other glaucomatous findings were included. ‘Conversion to primary open-angle glaucoma (POAG)’ was assessed as either red-free retinal nerve fiber layer photography or standard automated perimetry, and participants were classified into two groups: Non-converter (no conversion to POAG) and Converter (conversion to POAG) group. The ability of baseline factors to predict the conversion were identified. A presence or absence of ‘temporal raphe sign’ on the baseline macular ganglion cell-inner plexiform layer (mGCIPL) thickness map was also evaluated
Results : During the 5-year follow-up, 19 eyes (26.4%) converted to POAG. A temporal raphe sign was observed much more frequently in the Converter (18 of 19) than in the Non-converter group (0 of 53). In multivariate Cox models, baseline factors that significantly predict POAG development includes: positive temporal raphe sign (hazard ratio [HR] 4.3, 99% CIs 1.2–17.9); greater fluctuation of follow-up intraocular pressure (HR 1.1, 99% CIs 1.4–3.0). The AUC of the temporal raphe sign was excellent (0.967; sensitivity 94.94%, specificity 98.46%) and greater than that of any other OCT parameters.
Conclusion : In assessing the likelihood of the elderly with large VCDR to develop POAG, identification of the temporal raphe sign on mGCIPL thickness map was very effective. Thus, those without this sign could be suspected as ‘age-related ONH change’ rather than glaucoma.
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